Children and teens who cut, overdose or otherwise harm themselves were nine times more likely to die by suicide, overdose or in an accident compared those of the same age and gender, found a new study. In fact, those who had harmed themselves were approximately 17 times more likely to die by suicide and 34 times more likely to die by a drug overdose or alcohol poisoning at a young age.
Self-harm is already a leading risk factor for suicide, the second most common cause of death in adolescents and young adults worldwide. In this study, girls harmed themselves three times more often than boys, and their rates of self-harm have been increasing substantially, particularly among girls in their mid-teens.
“This marked apparent increase prompts the urgent need to identify the causes of this phenomenon,” wrote Catharine Morgan, a research associate at the University of Manchester in the U.K., and her fellow researchers. “Our findings highlight the important role of primary care for early intervention and inquiry, monitoring, and targeting of children and adolescents who may not openly engage with healthcare services for their current self harming behavior.”
The researchers analyzed data from a database of medical records from 674 family medicine practices in England and identified 16,912 patients, ages 10-19, who had harmed themselves between 2001-2014. Nearly three in four of these youth (73%) were girls, and the remaining 27% were boys. Unsurprisingly, more than a third of these girls and over a quarter of the boys had been diagnosed with a depression or anxiety disorder.
Girls were also more likely to have an eating disorder, but boys were more likely to have a diagnosis of attention deficit hyperactivity disorder, autism spectrum disorder, conduct disorder or a type of schizophrenia disorder.
Among the 13,980 records that included the method of self-harm, the most common method reported was a drug overdose, seen in 83% of patients. Self cutting, seen in 12.3% of the youth, was second most common, followed by 2.5% with a non-drug self poisoning. The remaining 1.1% harmed themselves by hanging, suffocation, jumping or scalding.
The rate of self-harm among girls was 37 per 10,000 a year, triple that of boys, whose annual rate was 12 per 10,000. Girls between ages 13-16 showed a particularly steep increase in self harm from 2011-2014, jumping 68% from 46 girls to 77 girls per 10,000.
One in five of these youth who self-harmed did so again within one year of their first episode, with girls slightly more likely than boys to self harm again. Although most of those who harmed themselves again did so only one more time, 18% had two additional episodes and 8% had three additional episodes of self-harm within a year.
The researchers also analyzed the risk of death for 8,638 patients who had previously harmed themselves, including 74% girls and 26% boys. The scientists matched each of those patients with up to 20 others of the same age and gender for comparison, a total of 170,274 comparison children and teens who had not harmed themselves.
Those who had a previous episode of self harm were approximately 17 times more likely to die by suicide during the follow-up period than those without a history of self harm. The follow-up period ran from their self-harm incident to 2014. The risk of death from a drug overdose or alcohol poisoning was also 34 times greater among those who had self-harmed, and their risk of dying in an accident was 6 times greater.
Despite these high risks of suicide, fatal overdose and accidental death, the teens don’t appear to be getting the help they need. This study was conducted in England, not the U.S., but services are actually likely to be more accessible and affordable for most teens in the U.K. given the structure of their healthcare system. Much research in the U.S. has already identified inadequate mental health services for youth.
In this study, adolescents in poorer areas were more likely to engage in self harm, but they were 23% less likely to receive a referral for mental health services within a year of their self-harm incident.
Worse, more than half of all teens who self-harmed (56%) did not receive a referral to mental health services at all. Among those who did receive referrals, 14% had received them before the self-harm incident, 18% were referred within a year after the incident and 14% were referred more than a year afterward.
A little more than one in five youth with a self-harming incident received antidepressant prescriptions, including 23% of girls and 20% of boys. But boys were more likely to receive prescriptions for hypnotic drugs or drugs to treat anxiety or psychosis (hallucinations and/or paranoia) within a year after a self-harm incident.
“Further development of appropriate interventions is needed as there is little evidence of a consistent clinical management approach for self harm among children and adolescents, especially in primary care settings,” the authors concluded.
“The increased risks of all cause and cause specific mortality observed emphasize the urgent need for integrated care involving families, schools, and healthcare provision to enhance safety among these distressed young people in the short term, and to help secure their future mental health and wellbeing,” the researchers said.
